FUNMILAYO AREMU-OLAYEMI examines special vaccines, the diseases they prevent, the associated risks of not administering them to children, challenges parents face with child vaccination and recommendations from paediatricians.
KHADIJAT, a nursing mother, hurried into the hospital with her six-week-old baby securely strapped to her back as she was two hours behind schedule for her baby’s immunisation. When she reached the immunisation clinic section, she noticed she was the last mother to arrive and then took a seat across from one of the nurses on duty.
The nurse inquired about the vaccines she Khadijat was in the clinic for and she replied that her baby was only six weeks old and sought clarification on which vaccines were appropriate for that age.
The nurse told Khadijah that at six weeks, her baby was due for Penta, OPV1, PCV1, and Rotavirus 1 vaccinations, adding that there’s an alternative vaccine called Hexaxim which is similar to Penta but less likely to cause fever or restlessness. The upside to it is that it comes at a higher cost.
Khadijat, thereafter, sought further clarification from the nurse.
“If you had arrived earlier, you would have caught the introductory lecture we usually provide at the start of the vaccination session,” the nurse explained. “There are special vaccines beyond the routine ones, such as MMR, Varicella, Flu, Hep A, Cholera, and others, which are not subsidised by the government. You’ll need to decide whether to opt for Hexaxim or stick with Penta for your baby.”
Armed with this information, Khadijah opted for the Penta vaccine, along with the other routine vaccinations recommended for a six-week-old infant. Although she was willing, she was unable to afford the Hexaxim vaccine, which could have mitigated the side effects associated with the Penta vaccine, as such, she chose to proceed with the standard immunisation schedule.
Khadijat would later tell Sunday Tribune her concerns about the special vaccines not being part of the routine vaccines.
Enquiries by Sunday Tribune revealed that the vaccines currently on the Nigerian Programme on Immunisation are BCG: Bacillle Calmette Guerin, OPV: Oral Polio Vaccine, HBV: Hepatitis B, Vit A, PCV: Pneumococcal conjugate vaccine, PENTA: Pentavalent vaccine (comprising diphtheria, pertussis, tetanus, Haemophilus influenza type b, hepatitis B) IPV: Inactivated polio vaccine, Rota, Measles, Yellow Fever, Mening A, and PENTA Booster.
It was discovered that these vaccines, routine and special, are taken at different ages and have a specific number of doses to be administered to children.
Checks also showed that the current immunisation schedule in Nigeria includes BCG, OPV 0, HBV at birth; OPV 1, PCV1, Rotavirus 1, Penta 1 at six weeks; OPV 2, PCV 2, Rotavirus 2, Pentavalent 2 at ten weeks; OPV 3, PCV 3, IPV, Pentavalent 3 at 14 weeks; Vitamin A at six months; Measles, Yellow fever, Meningitis vaccine at nine months; Vitamin A at 1 year.
It was also gathered that Vitamin A is given every six months till the age of five years, and Measles 2 at 15 months.
Further findings by Sunday Tribune revealed that the special vaccines are Hexaxim, Flu, Varicella, Hepatitis A, Typhoid, Cholera Mening ACYW135: Quadrivalent meningococcal conjugate vaccine, and MMR: Measles, Mumps, Rubella. These vaccines are also given at different ages and have a specific number of doses to be administered to children.
It was also discovered that these special vaccines are very expensive, especially for the masses in Nigeria. The current costs of the vaccines are as follows: MMR (three doses) costs N15,000 per dose; Varicella (two doses) costs N40,000 per dose; Hexaxim (four doses) costs N32,600 per dose; Flu (three doses) costs N13,600; Mening ACYW135 (two doses) costs N27,500; Cholera (two doses) costsN14,200; Hepatitis A (two doses) costs N18,500 and Typhoid (two doses) costs N15,000.
This raises questions about what illnesses the special vaccines protect against, and why they not subsidised by the government if they overlap with routine vaccines. Aside from that, it also begs the question of how many parents are knowledgeable about the vaccines and the reason behind getting them for their children as well as the costs and affordability of the parents.
Special Vaccines Beyond the Reach of Average Nigerians
Sunday Tribune went on to speak with nursing mothers to find out if they are aware of these vaccines and if their babies take these special vaccines.
Another nursing mother who spoke with Sunday Tribune on the condition of anonymity revealed that she doesn’t care about the special vaccines because she has always believed that if it was necessary then it would have been part of the routine vaccines subsidised by the government.
She said her mother gave her the same routine vaccines and she is in good health, adding that she believes that people who give their children special vaccines have the money to spare as she heard that the vaccines are quite expensive.
In her words, “I have heard about the special vaccines but I don’t care about them. My mother gave me the available routine vaccines and I am doing the same for my child, I am very healthy, so my child doesn’t need the special vaccine. If it was really necessary, I believe it would have been subsidised by the government.
“With the situation of things in the country, I can’t afford to take the special vaccines. Those taking them have the wherewithal to do so.”
Another nursing mother who wished to be identified as Iretiola said her baby has not missed the special vaccines she’s supposed to take for her age.
“My baby is ten months old now, and she has been taking the special vaccines from when she was six weeks old. I chose to pay for it because I would rather have peace of mind and not have to deal with a sick and fussy baby. I think it’s a small price to pay for the comfort of my baby.
“Last month, she took MMR, Mening ACYW and the routine ones too. I would rather give my baby the special vaccines than be admitted to the hospital for a disease that could have been prevented,” she said.
Mrs Tomi Aremu who also spoke with Sunday Tribune revealed that her baby took some of the special vaccines but could not continue with the other doses as they became too expensive for her to afford.
Paediatricians also spoke with Sunday Tribune on the significance of the special vaccines, the potential risks of not administering them and concerns regarding subsidies.
Diseases Special Vaccines Prevent
To understand the importance of these vaccines and recognise the roles they play in preventing diseases and which diseases they prevent, Sunday Tribune inquired of paediatricians to provide insight on the matter.
A consultant paediatrician at the University of Benin Teaching Hospital, Dr Emmanuel Eyo-Ita, revealed that these special vaccines guard against very serious illnesses and their associated complications like blindness, mental retardation, fertility problems and even death.
Providing an overview of the diseases the special vaccines guard against, he said: “Most of the vaccines are named according to the illnesses that they’re supposed to prevent. MMR is Mumps, Measles, and Rubella. Mumps occurs commonly in children and is a little scarier in boys because it can affect the testes. Usually, they present as jaw swelling, that is, swelling of the parotid glands. Measles, we all know and we have measles outbreaks now and again.
“There’s that measles season towards December every year. And then rubella is pretty similar to measles. It is called German measles, not because it has anything to do with Germany. It is more worrisome in women of reproductive age because if a pregnant lady has rubella, then that child can end up with something we call Congenital Rubella Syndrome. It’s quite nasty. It can lead to mental retardation, it can affect the eyes, it can have cataracts, it can affect the heart, affect the skin and the liver, those babies typically wouldn’t do well.
“So, are these vaccines important? Absolutely. Yes. In more civilised climes, particularly in Europe, they would intentionally check mothers to see whether they have sufficient antibodies, the antibodies give you an idea about whether a person has sufficient immunity against certain diseases. They will usually check every pregnant lady to see if she has sufficient immunity against rubella. It’s preventable. You don’t want the babies to come down with these issues,” he explained.
For MeningACYW, he explained that the vaccine takes care of four different organisms that commonly cause meningitis and is more common in the Sahara Sahel parts of Nigeria.
He disclosed that it typically ends in death and when it doesn’t and treatment is not started early, it could result in complications like blindness, deafness, seizures, and mental retardation as meningitis is an infection within the brain.
He also added that “meningococcal meningitis is very contagious. If a child gets it, he/she will get it into their airway first. So even when we have patients who have it, we immediately want to give the same antibiotics to the persons who have been in contact with that patient. It is that contagious, even when those people are not showing any symptoms.”
Also speaking with Sunday Tribune, a consultant paediatrician at the Federal Medical Center, Abuja, Dr Kefas Gurama, disclosed that Hexaxim and Pentavalent vaccines prevent the same diseases, the only difference is that babies that take the Pentavalent vaccine can have side effects like fever and convulsions but with Hexaxim, the side effects are lesser.
“Hexaxim is a different type of Pentavalent vaccine which the diphtheria part of it is Acellular with the addition of IPV for polio. However, the pentavalent consists of the formal DPT, HBV, and HIP. So, the DPT, D is for Diphtheria, which is a respiratory infection, a throat infection that went viral recently, and Tetanus is a common infection that can affect children, from birth, at any age and also in adults, too. Then the P is Pertussis. The one in the Hexaxim vaccine is the Acellular one. That one is believed to be less immunogenic and has fewer side effects. That is why developed countries adopted that because it has fewer side effects on their children. When children take the Penta that we have, some of them have a fever, and some will have convulsions. So, that is the essence of Hexaxim.
“For the Hepatitis B vaccine, we know what it guards against from the name; it prevents Hepatitis B with its attendant complications, like liver cirrhosis, and liver cancer, apart from hepatic failure that could occur. Influenza vaccine also guards against, pneumonia, and meningitis in children. IPV is the injectable form of the polio vaccine,” Dr Gurama said.
He added that Rubella in pregnant females can cause miscarriage if it affects the woman in the first trimester and towards the due date. He mentioned that the child could also have complications like abnormal holes in the heart, cardiac problems, retinosis, CNS infections like meningitis, etc. For Mumps, he mentioned that it affects the gonads in men and boys can have Orchitis which is an infection of the testicles and such children can develop fertility issues if not well handled.
Speaking on the Varicella vaccine, Dr Gurama said it prevents chicken pox, a condition which comes with itchy skin rashes and also has its attendant complications like infections, which can also affect the brain. For Hepatitis A, he said it prevents hepatic failure which can lead to death.
When asked if the routine ones and the special ones overlap or cover for each other in any way, Dr Gurama explained that the Hexaxim and the Pentavalent do the same work but the Hexaxim comes with fewer side effects.
According to him, “The scientists who produce these special vaccines won’t have wasted time and resources if the routine could do the same work as the special vaccines. The Hexaxim and the Pentavalent can do the same work, but the major component in the Hexaxim is the Acellular Pertussis. The major difference is the side effects which can occur when you use the routine Pentavalent. Hepatitis B cannot cover for Hepatitis A. No routine vaccine can cover Influenza, Varicella, Mumps, and Rubella. For meningitis, it is caused by different organisms, and the ACYW in the special Mening vaccine covers different strains. Typhoid and Cholera cannot also be covered by any of the routine vaccines.”
Both Dr Eyo-Ita and Dr Gurama believe that these vaccines are important given the diseases they prevent and their use in the developed world.
Risks and Challenges
On the risks associated with not administering these special vaccines, Dr Eyo-Ita confirmed that low vaccination rates of these special vaccines will impact public health, warning that there could be future outbreaks of these diseases if the vaccines are not administered. He said every single one of the diseases could result in an outbreak.
He explained that the rise of anti-vaxxers, who campaign against the use or administration of vaccines to children, in Europe and America, has brought about a significant reduction in vaccine uptake and consequently, there has been an upsurge of cases of measles, rubella and other vaccine-preventable diseases.
He added that: “A principle called herd immunity is very important. Herd immunity means that the more people in the community who have sufficient immunity against this particular disease, the less likely the unimmune people in that same community are to have it. Herd immunity is important when we talk about immunology and immunity against diseases generally.
“But, if we continue to mess around with these diseases as we have been doing, then yes, we will just continue to suffer from it and continue to suffer the consequences and more and more people will gradually keep getting infected and will keep seeing the repercussions whether the immediate or the short term or long-term complications of these diseases.”
Dr Eyo-Ita explained further that “the ripple effect of ill health is enormous and endless. As much as possible, the world as a whole is moving towards preventive, instead of curative medicine. As a parent, if I can prevent my child from having measles so that I don’t have to go to the hospital, pay for a consultation, buy certain medications, etc, then I would very much rather do that. If I can prevent my child from having meningitis and ending up with complications like seizures, which means that for the next five, ten, 20 years or the rest of that child’s life, I have to buy anticonvulsants that are expensive, then I would.
“On the family, it ensures that the economic stability of the family is assured. In the society, if breadwinners have to take time off work to be in the hospital for days because his or her child is suffering from a vaccine-preventable disease, the breadwinner’s place of work will lose for those number of days.
“Let’s also look at the health care worker, who presumably profits from people being ill. The truth is I would rather spend my time researching and coming up with new treatments for other illnesses than spending my time treating common illnesses. So, it would be better for me if I had five patients who had some really serious illnesses rather than spending my whole day swimming in 200 patients who are coming to me with apparently common severe illnesses, which we already have preventive measures.
“So, both the family, the individual, the economy as a whole, the health care workers and health care system would all benefit enormously from us preventing these illnesses rather than needing to treat them, which is what we’re spending so much time, energy, money and resources doing right now.”
Speaking on the challenges parents face with the immunisation of their children, Dr Gurama highlighted, availability, affordability and ignorance.
He said: “Well, the major thing is the awareness many people should be aware, and I believe, the general awareness on the baseline is above average. There are still some cases of beliefs and cultures where they don’t believe in immunisation.
“However, there’s the issue of affordability, some of these vaccines are very expensive because when you talk about the production of this vaccine and where they are produced, most of the time they are produced outside the country. The exchange rates have a way of affecting it. Some of these vaccines cost about N40,000. So, affordability is another issue.
“I want to mention the Human papillomavirus. The government launched it in October last year and they brought some doses to the hospital and the hospital gave that to children, but after that, they have not brought it again. It is meant to be free, and part of the routine vaccines. It is for female children, between nine and 14 years. So that’s another aspect that we need sustainability of this supply. For some of these vaccines, inflation can even affect their availability. Like Hepatitis A vaccine has not been available in Abuja, and I believe the country for some time now, so these are aspects that the inflation and exchange rate are affecting.”
Dr Eyo-Ita also mentioned that the vaccines are only called special vaccines as an excuse for not having them as routine vaccines.
In his words: “I think we are being lied to by the government that decided to refer to them as special vaccines. Because they’re not special. It’s like you decide to call the illness, a special illness. There’s nothing special about it. It’s an illness. So, they decided to tag them as special vaccines to have an excuse for not having them as one of the routine vaccines that everybody should receive.”
Recommendation
Dr Gurama advised that medical staff should give parents information on the vaccines, adding that the internet can also be a veritable source of information for many. He also disclosed that many children are not fully vaccinated because their parents are not aware that even the routine vaccines have boosters which their children need.
According to him, “Some of these so-called routine vaccines have boosters that children are supposed to be given even up to the age of five and ten. You need to give them boosters. When they start school, at the age of five, at the toddler age, between 18 months and three years, at those ages, they need some boosters.
“At age 10 to 12 years, they also need boosters of some of those vaccines. Even though they are given routinely, the commitment and the awareness are not well spelt out. Most parents, including the educated ones, don’t know their children are supposed to receive these boosters. Sometimes, they just manifest, they go to college, and the child comes down with Typhoid, Meningitis, and Pertussis which Penta booster could have prevented. There is a knowledge gap in that area. The drugs are available, the awareness is a problem,” he said.
Dr Eyo-Ita and Dr Gurama both recommended that the vaccines be subsidised because of their significance.
Dr Eyo-Ita noted that subsidising the vaccines will help increase the uptake and give more people access to the vaccines. In raising awareness, he advised that information should be put on flyers, and pamphlets, while healthcare professionals talk about them at antenatal clinics. He also advised that people who have children living with or survived vaccine-preventable diseases should share their experience at clinics.
“To raise awareness talk, jingles, put them on flyers, posters, make sure we’re talking about it at the antenatal clinics where a lot of people show up. Make sure it’s on the radio. Have colourful flyers and banners everywhere. Talk to people like me and put the information out there in the papers. Put the message in people’s faces as much as possible.
“What can we do to increase the uptake is where subsidising comes in, and making sure that it’s not so expensive or making sure that it is free. Everybody likes free stuff. Everybody wants to collect that which is free. Along with making sure it’s free, make sure you put out the right information and also take active steps to work against misinformation and disinformation.
He added that “any community, nation, or population that does not look towards the future is planning to be extinct and the future is the children. Health is wealth. If we want to build a successful nation, then we need to ensure that the children coming behind us have everything that they need to ensure that they can make the country work and if there’s one gift, we can give to them after things like education and nutrition, is making sure that they stay healthy.
“Vaccines are there to prevent certain illnesses that have the potential to rob these children of health and good health. So why not? Why don’t we vaccinate them? Make sure that they stay healthy. Let’s even be selfish and sure that we have a better life when we are much older and we need to rely on them to take care of us and to make the right decision, to run the government, etc.”
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